Ontario Licence Appeal Tribunal

The applicant sought statutory accident benefits following a 2021 motor vehicle accident.

The Tribunal found the applicant sustained a catastrophic impairment under Criterion 8 due to marked impairments in all four areas of function (activities of daily living, social functioning, concentration, persistence and pace, and adaptation) stemming from accident-related mental and behavioural disorders, including somatic symptom disorder and exacerbated PTSD.

However, the Tribunal dismissed the claims for a non-earner benefit, attendant care benefits, and various treatment plans, finding the applicant did not suffer a complete inability to carry on a normal life and failed to prove the treatment plans were reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an orthopaedic assessment.

The respondent denied the benefits, initially relying on the Minor Injury Guideline (MIG), though the MIG was later conceded.

The Tribunal found the applicant entitled to the first physiotherapy treatment plan based on supportive clinical notes from his family physician.

However, the Tribunal dismissed the claims for subsequent physiotherapy plans and the orthopaedic assessment due to a lack of medical evidence demonstrating they were reasonable and necessary.

The claim for a special award under s. 10 of O. Reg. 664 was dismissed as the insurer's conduct did not rise to the level of being unreasonable, given the applicant's failure to provide requested medical documentation.

The applicant requested a reconsideration of a previous Tribunal decision that held him to the Minor Injury Guideline (MIG) and denied his treatment plans.

The Vice-Chair found that the original decision contained a factual error regarding the interpretation of a CT scan report, which did not rule out a concussion as previously concluded.

Upon re-hearing the matter, the Vice-Chair determined that the applicant's consistent neurological symptoms supported a concussion diagnosis, removing him from the MIG.

The applicant was awarded funding for physiotherapy, massage, and occupational therapy (excluding travel time), plus interest.

The claim for a special award was dismissed.

The applicant sought payment for the unapproved balances of two treatment plans for social work services following a motor vehicle accident.

The respondent had approved the plans but reduced the provider's hourly rate from $139.00 to $100.00.

The Tribunal found that the provider, a registered social worker, was qualified to provide psychotherapy and Cognitive Behavioural Therapy, and that her services were comparable to those of a psychologist.

The Tribunal ordered the respondent to pay the unapproved balances of $1,014.00 and $1,348.00, plus interest.

The appellants appealed a decision by Tarion Warranty Corporation partially denying their claim for a deposit refund following a builder's insolvency.

While Tarion paid $40,000 based on the original 2016 purchase agreement, the appellants argued they were entitled to a higher limit based on their 2021 assignment purchase.

The Tribunal agreed with the appellants, finding that the deposit was paid in 2021 under the assignment agreement, entitling them to an additional $60,000 from the guarantee fund.

The appellants' requests for costs and disbursements were denied.

The applicant insurer sought repayment of $4,228.57 in overpaid Income Replacement Benefits (IRBs) from the respondent insured, plus interest.

The respondent acknowledged the overpayment but disputed the repayment method, arguing for a monthly repayment schedule capped at 20% of the monthly IRB under s. 52(4) of the Statutory Accident Benefits Schedule.

The Tribunal found that s. 52(2)(b) only applies when IRBs are actively being paid, which was not the case here.

The Tribunal ordered the respondent to repay the full lump sum of $4,228.57, plus interest, and denied the respondent's request for costs.

The applicant requested a reconsideration of a Tribunal decision that barred him from proceeding to a hearing for non-earner benefits due to a material misrepresentation and found him subject to the Minor Injury Guideline (MIG).

The applicant argued the Tribunal failed to properly consider medical evidence, erred in its treatment of an investigation report, and demonstrated bias.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate issues and advance new arguments not raised at the initial hearing.

The Tribunal concluded it had properly weighed the evidence, including surveillance and medical reports, and found no evidence to support the allegations of bias.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain syndrome.

The Licence Appeal Tribunal found the applicant failed to meet his burden of proof, noting a 28-month gap in medical reporting regarding functional impairments and evidence that he had returned to full-time work.

As the applicant's injuries were deemed predominantly minor and the MIG limits were exhausted, his claim for $1,926.60 in physiotherapy services and interest was dismissed.

The appellant appealed the impoundment of her vehicle under the Highway Traffic Act, arguing it would cause exceptional hardship.

The vehicle was impounded after the appellant was caught driving with a suspended licence.

The Tribunal found that the impoundment caused exceptional hardship because the appellant and her partner lived in a rural area with no public transit, and the lack of a vehicle threatened the partner's employment and the health and safety of their newborn child.

The appeal was allowed and the Registrar was ordered to release the vehicle.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought statutory accident benefits for physiotherapy, chiropractic services, and the cost of preparing a guardianship application.

The Licence Appeal Tribunal found the physiotherapy and chiropractic treatment plans to be reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the respondent's paper-review assessor.

However, the Tribunal denied the claim for the guardianship application, ruling that legal costs associated with obtaining an order appointing a litigation guardian are not covered under the Schedule.

The respondent insurer requested reconsideration of a Licence Appeal Tribunal decision finding that the applicant was involved in an 'accident' under the Statutory Accident Benefits Schedule.

The applicant had been injured while driving an ATV that collided with a tree on private property, though she had travelled on a public roadway for part of the trip.

The adjudicator granted the reconsideration request, finding that the original panel made an error of law by distinguishing binding appellate authority (Copley and Bouchard) on superficial factual grounds without addressing the underlying legal principles regarding the 'time and circumstances' of the accident.

The original decision was cancelled and a rehearing before a new adjudicator was ordered.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought payment for outstanding balances on six treatment plans for psychological services and $400 for housekeeping benefits.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to justify billing a psychotherapist's services at the higher hourly rate of a psychologist.

The claim for housekeeping benefits was denied because the applicant provided no evidence that the expenses were actually incurred or reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit and five physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, relying on section 44 insurer's examinations.

The Tribunal found that the applicant failed to demonstrate a complete inability to carry on a normal life, as the medical evidence indicated she could resume a substantial amount of her pre-accident activities.

The Tribunal also found the applicant failed to prove the physiotherapy treatment plans were reasonable and necessary, noting the lack of evidence showing how treatment goals were being met and the section 44 assessor's conclusion that she had reached maximum medical recovery from facility-based rehabilitation.

The application was dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing her injuries, including carpal tunnel syndrome, psychological impairments, and chronic pain, warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant failed to establish that her physical, psychological, or chronic pain impairments were caused by the accident or warranted removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to submit a required Disability Certificate and did not meet the test of suffering a complete inability to carry on a normal life.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claim for income replacement benefits.

The applicant argued that the Tribunal breached procedural fairness by holding a written hearing, made errors of fact and law regarding her non-compliance with document production requests, and failed to consider medical evidence regarding her post-104 week IRB entitlement.

The Vice-Chair dismissed the request, finding that the applicant failed to establish any grounds for reconsideration under Rule 18.2.

The applicant did not show a good reason for requiring a videoconference hearing, attempted to re-litigate findings of fact, and failed to explain why the medical evidence could not have been provided at the original hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained psychological impairments warranting removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove on a balance of probabilities that she suffered an accident-related psychological impairment, noting a lack of corroborating medical evidence and questioning the reliability of the psychological assessment report.

As the applicant remained within the MIG, her claims for treatment plans and assessments beyond the MIG limit, as well as interest, were dismissed.

The applicant sought entitlement to various statutory accident benefits following a motor vehicle accident, including treatment plans for a retroactive attendant care assessment, massage therapy, rehabilitation support worker services, optometric services, occupational therapy, and psychological services.

The Tribunal found the applicant was entitled to the $2,200.00 retroactive attendant care assessment because it covered a different post-accident period than the approved in-home assessment and was supported by medical evidence of functional limitations.

The remaining treatment plans were denied, largely because the applicant failed to establish they were reasonable and necessary, or because administrative costs exceeded the Professional Services Guideline limits.

The applicant's claim for an award under s. 10 of Regulation 664 was also dismissed.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his Class G driver's licence due to cognitive impairment.

The suspension was based on a Medical Condition Report from a geriatrician and a subsequent Functional Driving Assessment which concluded the appellant was not fit to drive.

The appellant argued the cognitive testing was discriminatory and unreliable due to his hearing impairment and language barriers, and that his privacy rights were violated.

The Tribunal found that the medical and functional evidence, including the on-road assessment documenting significant functional deficits, established that the appellant suffers from a medical condition likely to significantly interfere with his ability to drive safely.

The appeal was dismissed and the licence suspension was confirmed.

The applicant sought a non-earner benefit (NEB) following a motor vehicle accident.

The respondent denied the NEB but failed to provide the applicant with a benefit election form or clear notice of her requirement to elect between an income replacement benefit and an NEB, triggering the 'shall-pay' provisions of the Schedule.

However, the applicant failed to comply with the respondent's subsequent requests for information under s. 33.

The Tribunal ordered the respondent to pay the NEB for the period between the submission of the disability certificate and the applicant's non-compliance with s. 33, with interest.

The claim for an award for unreasonable delay was dismissed.

The applicant sought accident benefits following a motor vehicle accident, claiming a psychological condition warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's evidence, including clinical notes and a social worker's assessment, insufficient to establish a psychological condition caused by the accident, noting the symptoms were more likely related to an unrelated chronic health condition.

As the applicant remained within the MIG and the limits were exhausted, the claim for a psychological assessment was denied, along with claims for interest and a special award.